Anxiety

Anxiety: Excerpt from In a Page: Signs and Symptoms

Anxiety includes symptoms of physiologic arousal (e.g., autonomic hyperactivity, increased motor tension) and psychological arousal (e.g., excessive worry, increased vigilance). It may present as a primary psychiatric condition or secondary to a broad variety of medical and psychiatric diseases.

Differential Diagnosis

• Generalized anxiety disorder
  –Excessive worry associated with at least three symptoms, including restlessness or edgy feeling, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
  –The most common anxiety disorder in primary care
• Panic disorder
  –Recurrent, unpredictable panic attacks with intense apprehension, fear or terror, and somatic symptoms (e.g., tachycardia)
  –May present with or without agoraphobia
• Depression: Anxiety often presents in a mixed state with depression
• Medications (e.g., bronchodilators, steroids, antidepressants, antihypertensives)
• Substance use, including drugs (e.g., alcohol, caffeine, cocaine, cannabis)
• Obsessive-compulsive disorder
  –Obsessions are persistent ideas, images, or impulses that generate anxiety
  –Compulsions are intentional repetitive behaviors or mental acts aimed at reducing the distress of obsessions
  • Anxiety disorder due to a general medical condition
    –Cardiovascular etiologies include MI, angina, arrhythmias, CAD, CHF, MVP
    –Respiratory etiologies include asthma, COPD, and pulmonary embolism
    –Endocrine etiologies include hyper- or hypothyroidism, hypoglycemia, and Cushing's syndrome
    –Neurological etiologies include Parkinson's disease and epilepsy
    –Cancer
  • Pheochromocytoma: Adrenal tumor that usually presents with hypertension and increased heart rate and sometimes with fright reaction of sweating, headache, and pale facial appearance
  • Parkinson's disease: Presents with tremor at rest, usually in one hand (as opposed to the more generalized essential tremor in anxiety)
  • Post-traumatic or acute stress disorder
  • Social anxiety disorder
  • Specific phobia
  • Bipolar disorder (especially manic stage)

  Workup and Diagnosis

  • Detailed history of onset, duration, and type of anxiety symptoms as well as specific events, stressors, or medical illnesses that produce anxiety
    –Complete drug and medication history, including caffeine, alcohol, over-the-counter preparations, herbals, illicit drugs, and prescription drugs
    –Physical exam should be directed toward ruling out organic medical diseases that may present with anxiety, including cardiovascular, pulmonary, endocrine, and neurologic disorders
    –A complete psychiatric examination is indicated for all patients (e.g., appearance, sleep evaluation, mini-mental status exam, affect)
  • DSM-IV criteria are used to determine the specific psychiatric disorders
  • No diagnostic tests are indicated except those that may determine underlying medical disorders (e.g., thyroid function tests, ECG, urine catecholamines)

  Treatment

  • Patient education regarding available treatment and reassurance often has a calming effect
  • Treatment usually combines pharmacologic and nonpharmacologic approaches, including cognitive-behavioral therapy, relaxation training, and biofeedback
  • General anxiety disorder: Cognitive therapy has been proven to be beneficial; benzodiazepines, buspirone, and antidepressants (tricyclic antidepressants, SSRIs) are all effective; however, concern over dependence sometimes limits the use of benzodiazepines
  • Panic disorder: SSRIs, tricyclic antidepressants, benzodiazepines, and cognitive-behavioral therapy are equivalently effective
  • Obsessive-compulsive disorder: High-dose SSRIs and cognitive-behavioral therapy are effective

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Agoraphobia

• Back to disease: Agoraphobia: Introduction
• Next Book Extract About Agoraphobia: DEPRESSION, ANXIETY, AND OTHER ABNORMAL PSYCHIC STATES (Differential Diagnosis in Primary Care)
• More Book Extracts: All Online Books for Agoraphobia

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: DEPRESSION, ANXIETY, AND OTHER ABNORMAL PSYCHIC STATES (Differential Diagnosis in Primary Care)

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